In vivo arterial stiffness is a dynamic property based on vascular function and structure. It is influenced by confounding factors like blood pressure (BP), age, gender, body mass index, heart rate, ...and treatment. As a consequence, standardization of the measurement conditions is imperative. General and method/device-specific user procedures are discussed.
The subject’s conditions should be standardized before starting measurements. These conditions include a minimal resting period of 10 min in a quiet room. It also includes prohibitions on smoking, meals, alcohol, and beverages containing caffeine before measurements. The position of the subject and time of measurements should be standardized. In comparative studies, corrections should be made for confounding factors. Repeated measurements are done preferably by the same investigator, and if available validated with user-independent automated procedures.
As it is not feasible to discuss all methods or devices measuring arterial stiffness in one article, more attention is given to user procedures of commercially available devices, because these devices are of interest for a wider group of investigators. User procedures of methods/devices are discussed according to the nature of arterial stiffness measured: systemic, regional, or local arterial stiffness.
Each section discusses general or method/device-specific user procedures and is followed by recommendations. Each recommendation discussed during the First International Consensus Conference on the Clinical Applications of Arterial Stiffness is quoted with the level of agreement reached during the conference. Also proposals for future research are made.
Rheumatic disease patients are at greater risk of infection due to their disease, comorbidities, and immunosuppressive therapy. COVID-19 outcomes in this patient setting appeared to be similar to ...those of the general population. However, data on this topic were mainly related to small studies on a limited number of patients. Consequently, to date, this field remains poorly explored, particularly in the pre-vaccine era. This monocentric study aimed to describe the intrahospital mortality in rheumatic patients with SARS-CoV-2 consecutively hospitalized from 21 February to 31 December 2020, before anti-SARS-CoV-2 vaccine administration spread, compared with non-rheumatic patients. Of 2491 included patients, 65 3%, median (interquartile range) age 75 (64.76-82.239 years, 65% women were suffering from rheumatic diseases. A total of 20 deaths were reported case fatality rate 31%, 95% confidence interval (CI): 19-42 compared with 433 deaths (19%, 95% CI: 17-20) in patients without rheumatic diseases (p=0.024). However, the rheumatic disease was not associated with a significant increase in univariate mortality hazards (hazard ratio 1.374, 95% CI: 0.876-2.154), and after adjustment (hazard ratio 1.199, 95% CI: 0.759-1.894) by age, sex and Charlson comorbidity index. The incidence of intensive care unit admission, death, and discharge in the case-control study was comparable between rheumatic and non-rheumatic patients. The presence of rheumatic diseases in SARS-CoV-2-hospitalized patients did not represent an independent risk factor for severe disease or mortality.
This study is part of a more complex research aimed at establishing guidelines to simplify the digitalization process used to manage existing building heritage. Working in a BIM environment, this ...paper will present two different algorithms: a modelling algorithm, a data analysis algorithm, and relative applications in the digitalization of a contemporary building. All the archival data required for the digitalization process was collected and those in two-dimensional digital vector format have aroused particular interest because they enabled initiation of the reconstruction process of the BIM model. One of the two algorithms allowed us to identify recurrent elements in a CAD drawing, based on geometric 2D primitives. The final outcome of the first phase involves quadrilateral or circular surfaces and can be viewed in algorithmic environment. The next phase involves applying a unique coloured sign to the identified sections and then export them all in a BIM software. This tool produced unexpected positive results: the presence of a small coloured grid emphasized the discrepancies created between the two-dimensional drawings and the vertical elements. We were thus able to identify the objects with these inconsistencies: they were verified using accurate surveys and then corrected.
OBJECTIVE:Radiation Induced Heart Disease (RIHD) represents a late effect of chest irradiation, contributing in augmenting mortality in oncological patients by affecting pericardium, myocardium, ...valvs and coronaries. Currently, regarding the risk of coronary heart disease (CAD), a cardiological screening involving exercise stress electrocardiography after 5–10 years from radiotherapy is advised. We sought to determine the rate of ischemia at exercise stress electrocardiography in a population of patient without cardiovascular risk factors who sustained radiotherapy, using a cohort of high cardiovascular risk patients as control group.
DESIGN AND METHOD:A population of 115 patients who sustained chest irradiation, presenting without classic cardiovascular risk factors was evaluated with exercise stress electrocardiography. 135 patients with high profile of cardiovascular risk candidate to stress testing for primary prevention or for atypical symptoms served as control group.
RESULTS:The cohort of irradiated patients without classical cardiovascular risk factors was younger (48.7 ± 10.1 vs 60.5 ± 10.8 years, p < 0.001) and presents a lower percentage of males when compared with the control group. In this latter group 25.9% of subjects has diabetes, 62.9% dislipidemia, 67.4% hypertension and 19.2% actively smoke. Despite this important differences regarding classic cardiovascular risk factor no significant differences were founded in the number of positive exercise stress electrocardiography (10.4 vs 5.9%, p = ns).
CONCLUSIONS:Chest irradiation represent a strong cardiovascular risk factor, equalizing the rate of positive exercise stress electrocardiograms among two cohort of patients significantly different for the rate of classic cardiovascular risk factors.
OBJECTIVE:Endothelial Dysfunction (ED) of peripheral arteries in Chronic Heart Failure (CHF) subjects has been demonstrated. We assessed endothelial function in subjects undergoing unconventional ...treatments for CHF, namely Heart Transplantation (HTX), continuous-flow Left Ventricular Assist Device implantation (LVAD), and repeated levosimendan infusions (r-LEVO).
DESIGN AND METHOD:Twenty HTX recipients (median time from HTX 21 months), 20 patients supported with LVAD (median time from implant 39 months), and 20 patients receiving monthly Levosimendan infusions (median time on treatment 28 months) were enrolled and compared to a group of 20 healthy subjects. ED was evaluated with ultrasound assessment of the diameter before and after ischemic stress at the brachial artery level. The difference between the two diameters normalized for the baseline value (Flow Mediated Dilation - FMD) has been used for the analysis. All the patients were stable at the time of FMD assessment, with those on r-LEVO being evaluated prior to infusion.
RESULTS:FMD was significantly lower in HTX and LVAD groups with respect to controls (9.8 ± 7.4, 9.3 ± 5.7, and 15.6 ± 6.4% respectively, p = 0.01), but not in r-LEVO group (12.5 ± 6.9%).When patients were analyzed according to time from the operation or on treatment, (< versus > of the median value), no differences were seen in HTX and r-LEVO group, while in LVAD group FMD was borderline significantly higher in patients with longer follow-up (8.4 ± 6.4% versus 10.2 ± 5.2%, p = 0.05).
CONCLUSIONS:Based on this preliminary data we can inference the following1- FMD is abnormal in HTX recipients, despite their good functional status, probably due to factors unrelated to CHF (e.g. hypertension, renal insufficiency, denervation, and drug effects); 2- LVAD patients also show ED, with possible better adaptation in very long-term survivors; 3- Near-normal FMD values in CHF patients who remain stable with r-LEVO suggest that pulsed treatment may obtain favorable effects at peripheral level, persisting after clearance of the drug and its metabolites.
OBJECTIVE:Searching for a prognostic cut-off value of serum uric acid (SUA) in predicting myocardial infarction (MI) in a large regional-based Italian cohort of men and women in the frame of the ...URRAH study (URic Acid Right for heArt Health).
DESIGN AND METHOD:The ongoing large database URRAH collects data from studies and cohorts from hypertension centres and epidemiological laboratories, including subjects with at least 1 measure of SUA and a follow-up of ∼20 years. Incident myocardial infarction (MI) was defined in 23,475 subjects on the basis of ICD10 codes and double-checked with general practitioners and hospital files. Multivariate dichotomic Cox regression models having fatal and morbid MI as dependent variables, adjusted for arterial hypertension (AH), age, sex, diabetes, hematocrit, LDL-cholesterol, smoking and chronic renal disease were preliminarily used to search for an association between SUA as a continuous variable and MI. Two prognostic cut-off values (one for fatal and one for morbid MI), identified by means of receiver operating curves (ROC) and able to discriminate between subjects doomed to develop the event, were then used as independent predictors to divide people into those <cut-off and >cut-off in further multivariate Cox models adjusted for the confounders listed above.
RESULTS:In Cox analysis, SUA as a continuous variable was a significant predictor of fatal odds ratio, OR, 1.457 (1.029–1.240), p < 0.001 and morbid OR 1.254 (1.111–1.306), p < 0.0001 incident MI, independently of AH. ROC showed that >5.70 mg/dl (95%CI 5.10–6.42, sensitivity 46.6, specificity 71.3, p < 0.0001) was the prognostic cut-off value for fatal MI and >4.30 mg/dl (95%CI 3.79–5.20, sensitivity 79.5, specificity 34.0, p < 0.0001) for morbid MI. These two values were accepted as multivariate predictors in Cox analyses, the hazard ratios being 1.23 (95%CI 1.04–1.68, p = 0.022) for fatal and 1.73 (95%CI 1.22–2.47, p = 0.002) for morbid MI.
CONCLUSIONS:In conclusion, clear prognostic cut-off values of SUA for fatal (>5.20 mg/dl) and morbid (>4.30 mg/dl) MI do exist also after adjustment for confounders including AH.
OBJECTIVE:Cardiac Rehabilitation (CR) improves the functional capacity and the prognosis of patients with Coronary Artery Disease (CAD). Similar results have also been found in patients with Dilated ...Cardiomyopathy (DCM). Our study was aimed at assessing the relationship between functional improvement (evaluated with 6-Minute Walking Test – 6MWT) and the improvement in Left Ventricular Ejection Fraction (LVEF) after CR.Methodswe collected data from 260 patients that performed CR after an Acute Coronary Syndrome (ACS). The functional improvement after CR was expressed as the delta between distance covered at the final versus the initial 6MWT normalized for the initial 6MWT, while LVEF was calculated with transthoracic echocardiogram at the beginning and at the end of the CR.
DESIGN AND METHOD:We collected data from 260 patients that performed CR after an Acute Coronary Syndrome (ACS). The functional improvement after CR was expressed as the delta between distance covered at the final versus the initial 6MWT normalized for the initial 6MWT, while LVEF was calculated with transthoracic echocardiogram at the beginning and at the end of the CR.
RESULTS:In the whole population functional improvement was 44.07 % (baseline 6MWT 421.22 m vs follow-up 6MWT 597.28 m, p = < 0.05) while EF improvement was 2.48 % (baseline EF 53.37% vs follow-up EF 55.91%, p= < 0.05). No significant correlation between the normalized delta meter and delta EF was founded. When patients were divided accordingly to their pre-rehab LVEF (>=55, 40–55 and < 50%) we found a lower baseline 6MWT distance in the second and the third group with a higher improvement only in the second group (40 vs 50 vs 43% respectively, p=0.001). This latter group is also the one that presents the higher improvement in EF in comparison with the EF < 40% group (5 vs 3%, p = 0.04). No significant correlation between the normalized delta meter and delta EF was founded also when analysis was repeated in the different group depending on the EF values.
CONCLUSIONS:Our data confirm the CR related functional improvement that is not related to the relative increase in LVEF.
Objectives: Physical activity (PA) is a key factor in cardiovascular disease prevention. Through the Health Action Process Approach (HAPA), the present study investigated the process of change in PA ...in coronary patients (CPs) and hypertensive patients (HPs).
Design: Longitudinal survey study with two follow-up assessments at 6 and 12 months on 188 CPs and 169 HPs.
Main outcome measures: Intensity and frequency of PA.
Results: A multi-sample analysis indicated the equivalence of almost all the HAPA social cognitive patterns for both patient populations. A latent growth curve model showed strong interrelations among intercepts and slopes of PA, planning and maintenance self-efficacy, but change in planning was not associated with change in PA. Moreover, increase in PA was associated with the value of planning and maintenance self-efficacy reached at the last follow-up
Conclusions: These findings shed light on mechanisms often neglected by the HAPA literature, suggesting reciprocal relationships between PA and its predictors that could define a plausible virtuous circle within the HAPA volitional phase. Moreover, the HAPA social cognitive patterns are essentially identical for patients who had a coronary event (i.e. CPs) and individuals who are at high risk for a coronary event (i.e. HPs).
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